Bishop James M. Stanton, head of the Episcopal Diocese of Dallas, took the precautions a step further.

In a two-page letter, he counseled clergy on the importance of hand washing and use of sanitizer and on proper methods of washing and storing the chalice and plate used to serve communion.

He also suggested parishioners not be allowed to drink wine from a common chalice during communion or dip their wafers in wine.

“Persons who have the flu, sore throats, coughs, cold sores, etc. should be dissuaded from attending corporate worship services until they are well,” he wrote.

As to the “Passing of the Peace” — which is to the Catholic “Sign of Peace” — Stanton wrote that the observance “should be limited to the bowing of the head to one another or other forms of acknowledgment not involving physical contact of any kind.”

Both churches said the modified practices were also used during the swine flu epidemic in 2009.

During that outbreak, the Centers for Disease Control and Prevention recommended a six-foot buffer from sick people, an advisory that led many people to avoid handshakes and hugging.

David Tang, pastor of the 500-member Dallas Chinese Bible Church in Richardson, said that’s when his congregation started offering communion differently.

Instead of passing a common plate of bread, the loaf is broken into pieces to prevent the spread of germs.

But if someone reaches for his hand, Tang said, he’ll always meet them halfway — even if they’re coughing.

“I just make sure to be vigilant about washing my hands before touching my face,” he said. “Shaking hands is part of the church culture, and for me, it’s one way to greet someone and to show them we care and to let them know we’re glad they’re here to worship with us.”

Others seem reluctant to give up the practice, too.

Most business lunches still begin and end with handshakes, as do job interviews and even trips to the doctor.

Dr. Isaac Pugach, a primary-care physician who runs a clinic in Lake Highlands, said he never leaves anybody hanging.

“If a patient offers their hand, I always take it,” he said. “You never want to offend anyone, but from a medical point of view, this is a decision each individual needs to make.”

He suggested that a namaste — an Indian tradition of pressing palms together in front of the chest — followed by a gentle bow might be a polite gesture until the influenza outbreak subsides.

Shaking hands is a tradition that began as early as the fifth century B.C. to demonstrate that an extended hand did not carry a weapon. Today, it has evolved into a pleasantry and a quick assessment of someone’s confidence.

Lakehill Preparatory School headmaster Roger Perry said he’s sending children a message each day when he greets them with a hand pump.

“I believe it offers them reassurance that somebody cares, and it’s a symbol of shared respect back and forth,” he said.

“It’s a tradition worth continuing because it trains kids in a small and polite thing to do when they meet someone.”

Zachary Thompson, executive director of Dallas County Health and Human Services, said he’s found a way to reduce the spread of the flu virus and extend a warm greeting — the fist bump.

“I get my fist up fast and say, ‘Hey,’” said Thompson, who’s been spending a lot of time these days with crowds of vaccine seekers at the health department.

When Thompson can’t avoid a grateful handshake, he keeps sanitizing gel with alcohol nearby to wipe out lingering germs.

Dallas County Judge Clay Jenkins said the flu season is just an occupational hazard. Sometimes, politicians must press the flesh.

“After working on the Obama campaign, I am prone to fist bump,” he said. “If people will take a fist bump, I’ll give them one.”

If not, he hopes sanitizer and good luck will keep him healthy as he and his family prepare later this week for President Barack Obama’s inauguration in Washington.

“We’re really working hard not to catch the flu,” Jenkins said. “Everybody is healthy so far.”

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AT A GLANCE: SAFER GREETINGS

What the professionals say:

Decline a handshake if you have a cold. It is completely acceptable and polite to explain, “I have a cold and do not want you to get sick.”

Substitute another type of greeting for the handshake. To be polite, don’t reject a person altogether. Smile and choose a greeting option such as a bow, bump, peace sign, nod or namaste.

Go ahead, shake a hand. But wash up afterward with soap and water or hand sanitizer before touching your face or eating.

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AT A GLANCE: MINIMIZING EXPOSURE

Dr. Jane Sadler, who writes about health care for The Dallas Morning News, offers this advice about unnecessary office visits during the flu season:

• Patients who have scheduled physicals in the next several weeks should consider rescheduling their appointments if they have no urgent concerns.

• Don’t bring your healthy children along with your sick children to the medical office. If possible, find someone to care for your healthy children so they can avoid the contagion within the office.